Emotions in Medical Decision Making in Older Adults

描述(申请人提供)：医疗决策研究利用经济学和统计学的见解来建立临床决策的量化模型。这些模型依赖于有关决策者使用信息的假设，包括人们以狭隘的逻辑方式处理信息的核心假设。最近，决策者的心理，包括他们的情绪状态，正在被纳入这些模型，以增强认知的作用。对老年人的研究在许多方面与其他人群有重要的不同，这些方面可能会影响医疗决策，特别是情绪的作用。威廉·戴尔博士从他的论文开始从事他的工作，他将通过专注于更深入地理解老年人医疗决策中的情绪来加强他在老年病学和公共政策方面的跨学科培训。这项研究最初利用了前列腺癌的临床模型，前列腺癌是一种在老年男性中广泛流行的疾病，在这种疾病中，焦虑的情绪可能会影响决策。尽管对于检测和治疗前列腺癌的“正确”临床路径还没有达成共识，但人们普遍认为，患者的喜好对做出选择至关重要。初步调查表明，将焦虑纳入对患有局限性前列腺癌的男性的效用评估，极大地影响了治疗的成本-效果比。评估焦虑对这些男性效用评估的贡献的进一步研究正在进行中。这项研究是了解情绪在老年人医疗决策中的作用的总体职业目标的一个具体核心例子。老年人护理发生在一个复杂的社会-医疗-心理环境中，需要对诸如功能障碍、多重合并症、多药联用和照顾者负担等问题的重要性敏感。作为一名老年病学家，戴尔博士对在他的研究中纳入这些担忧很敏感。戴尔博士在导师的专家指导下，通过对心理学和医疗决策的有针对性的深入理解，加强了他在公共政策研究和老年病学方面的广泛培训，他将为研究情绪在老年人医疗决策中的作用的职业生涯积累必要的专业知识。

DESCRIPTION (provided by applicant): Research on medical decision-making makes use of insights from economics and statistics to build quantitative models of clinical decisions. These models rely on assumptions about the use of information by decision-makers, including the core assumption that people process information in a narrowly logical manner. Recently, the psychology of decision-makers, including their emotional states, is being incorporated into these models to augment the role of cognition. Research on older adults differs importantly from other populations in a number of ways that may impact medical decision-making, especially the role of emotions. Pursuing work begun with his dissertation, William Dale, MD, PhD, will enhance his interdisciplinary training in geriatrics and public policy by focusing on a deeper understanding of emotions in medical decision-making in older adults. This research agenda initially utilizes the clinical model of prostate cancer, a widely prevalent disease in older men, and one in which the role of the emotion of anxiety may influence decision-making. Although no consensus exists on the "right" clinical pathway for detecting and treating prostate cancer, there is wide agreement that patient preferences are vital for making choices. Initial investigations indicate the inclusion of anxiety in utility assessments for men with localized prostate cancer dramatically affect the cost-effectiveness ratios for treatments. Further research to assess the contribution of anxiety to utility assessments for these men is on-going. This study serves as a specific core example of the overall career goal of understanding the role of emotions in medical decision-making in older adults. Older adults care occurs in a complicated socio-medico-psychological context that demands sensitivity to the importance of issues such as functional impairments, multiple co-morbidities, polypharmacy, and care-giver burden. As a geriatrician, Dr. Dale is sensitive of including these concerns in pursuing his research. Enhancing his broad-based training in public policy studies and geriatrics with a targeted, in-depth understanding of psychology and medical decision-making under the expert guidance of his mentors, Dr. Dale will build the necessary expertise for a career researching the role of emotions in medical decisions for older adults.